Arsha (Hemorrhoids) is a very common ano-rectal condition affecting as much as half the population by age of 50, and represent a major medical and socioeconomic problem. Many treatment methods have been applied in management of Arsha (Hemorrhoids) disease ranging from dietary and lifestyle modification to para- surgery and surgery, depending on degree and severity of symptoms. It has been proved by scientific studies that Changeri (Oxalis Corniculata) improve microcirculation, capillary flow, and to strength the surrounding connective tissues of anus and lower rectum. The present case study deals with the oral supplementation of Changeri Ghrita in Arsha (Hemorrhoids) patients, which has prevented the expensive, time-consuming, painful management of Hemorrhoids with good result in symptomatic management of Arsha (Hemorrhoids).

 

Keywords: Changeri Ghrita, Management, Ayurveda, Arsha, Hemorrhoids

Introduction

Arsha (Hemorrhoids) are a common ano-rectal condition defined as the symptomatic enlargement and distal displacement of the anal mucosa. The most common symptom of Arsha (Hemorrhoids) is rectal bleeding. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of Arsha (Hemorrhoids). In India, Arsha (Hemorrhoids) was reported to affect 5.2 % of the general population. In Nepal no such study has been done yet. In most instances, Arsha (Hemorrhoids) are treated conservatively, using many methods such as lifestyle modification, fiber supplement, use of laxatives, anti-inflammatory drugs, and administration of veno-tonic drugs but all the methods has not given satisfactory results. The use of Changeri Ghrita could be a new dimension of Management of this disease. In Bhaisajyaratnawali, Grahaniroga, Chikitsaprakaran chapter 8, verse 561 described about the indication of Changeri Ghrita in Arsha.

Case History

A 40 old teacher who presented to OPD of District Ayurveda Health Center, Khandbari, Sankhuwasabha, with complain of rectal bleeding. His history went back about 2 years when he noticed there were streaks of bright red blood coating in his stool and spots of blood on the toilet pan. There was also an embarrassing itch around his anus for many days. Mass protrusion during defecation was noticed 6 months back which should be manually pushed after defecation. He was sure it was a case of hemorrhoids and he medicated himself daily with a laxative obtained from the local pharmacy. The condition seemed to have improved but he was alarmed by an unusually large smear of bright red blood on the toilet on the morning of his visit. The bleeding was not associated with pain. Further questioning revealed that he moved his bowel no more than 3 times a week, going to the toilet only when he felt the urge to go. Some degree of straining was always required and consistency of the stool was firm but not hard. There was no change in bowel habit and no family history of colonic cancer. He has always enjoyed good health with no previous surgical history.

 

On inspection no anal skin tags, external hemorrhoid, perianal dermatitis from anal discharge or fecal soiling, fistula-in-ano and anal fissure were noted. But during straining mass from 7 and 11 O clock position was seen (picture 1.1). Digital rectal examination was done and it was found that he had internal haemorrhoids at 7 and 11 O clock position. No abnormal ano-rectal mass, anal stenosis and scar was noted. Anal sphincter tone was normal, and size of Prostrate was normal.

His investigations were done and reports are given below.

1. Full blood count

• Hb – 15.7 gm/dL

• WBC – 7400/cumm

• ESR – 10 mm/hr

• Differential count

• Neutrophil – 71%

• Lymphocyte - 25%

• Monocyte - 2%

• Eosinophil – 2%

• Basophil – 0%

2. Renal function test

• Sodium- 141 mEq/l

• Potassium – 3.9mEq/l

• Urea – 21 mg%

• Creatinine – 0.8 mg%

3. Fasting Blood glucose – 72 mg%

4. LFT

• Bilirubin ( T) – 1.2mg%

• Bilirubin (D)- 0.5mg%

• Alkaline phosphate – 145

• SGPT – 28

5. Lipid profile

• Cholesterol – 112 mg/dl

• HDL- 38 mg/dl

• LDL - 18 mg/dl

• Triglyceride- 278 mg/dl

6. HIV, HCV, HbsAg – Non-Reactive

7. ECG – Normal

8. X-ray chest PA view- Normal Study

9. USG – Normal study

10. Colonoscopy – Not done

After history, examination and investigation the patient was diagnosed with Arsha (3rd degree hemorrhoids), patient was given following Ayurveda medicines.

1. Changeri Ghrita 15 ml BD for 30 days

Takra was advised as anupan.

Some life style modifications were advised such as:

• Eat fiber-rich food

• Do not consume Hot & Spicy foods.

• Drink plenty of water 

• Do not postpone bowel movement

• Do not strain during defecation

• Mild Exercise

• Sitz bath with Alum. 

 

 

After 15 days, the patient relieved symptomatically. He had no bleeding per rectum. Itching in perianal region was relieved. There was no mass protrusion during defecation. In clinical examination no mass recorded (picture 1.2) on staining which was present before the treatment and on digital anal examination also there was no mass recorded at 7 or 11 O clock position. Patient was advised for same medication and same lifestyle modifications for further 15 days. No Symptoms were recorded during that period also. No significant differences were observed in laboratory investigations after the treatment (shared with Rasamruta) and were in the normal range with a exception of Triglycerides. It has no clinical significance with the disease in consideration.

 

Before Treatment (picture 1.1)

 

After treatment (picture 1.2)

 

Discussion

 

The Ayurvedic texts have an abundant literature regarding the use of Changeri Ghrita. The anti-inflammatory, antiseptic, carminative, digestive, liver tonic, diuretic, venotonic property of Changeri Ghrita is a well evidenced observation. Fresh plant juice has property of curing dyspepsia, piles and anemia. However the current case study has dealt with the effect of Changeri ghrita on Hemorrhoids of Grade III. Sushruta Samhita states that Arsha can be treated by the four ways viz. Bheshaja (Internal medication), Kshara (Local application), Agnikarma (Cauterization), Shastrakarma (Surgery). This work is based on the principle of Aushadhi Chikitsa. Bhaisajya ratnawali mentioned Changeri Ghrita has a property of appetizer (Agnivardhaka) and Vedanashamak (Relieves Pain) so pain during defecation will be relieved. It also relieves Mutrakrichhra (Dysuria) so straining due to BPH will be relieved. Since Agnimandya is responsible for all types of the diseases, this Ghrita through its Agnivardhaka effect relieves the Agnimandya. This Ghrita acts on the large intestine through its Mala-bhedana effect. This result into the smooth excretion of stool, thereby providing a greater relief to the patients of hemorrhoids e.g. relief from pain during defecation, bleeding, perianal itches. Ghrita has property of malabhedak (Relieves constipation), Pachak (Digestive) and Balya (Energizer) which alters the patho-physiology of Arsha (Hemorrhoids). Takra (Butter Milk) was given as anupan as it is considered as best treatment of Arsha (Hemorrhoids) in Charak Samhita Chikitsasthan 14th chapter in 76 slok. Takra has a property of Jatharagni Pradipak (appetizer) and sroto-shodhak (Cleans the bodily channels).

 

Conclusion

 

Although precise mechanism of action remains unclear, the oral supplementation with the Changeri Ghrita prevents the time-consuming, painful and expensive complication of Arsha (Hemorrhoids). This case study may provide a new dimension to the treatment of hemorrhoids with the help of Alternate therapy viz. Changeri Ghrita.It was noted that the Arsha (Hemorrhoids) shrunk out with oral supplementation of Changeri ghrita and some life style modification with complete symptomatic relief. Hence, it could be stated that Changeri Ghrita was an effective method for the treatment of Arsha (Hemorrhoids).Life style modification also plays vital role in management of Arsha (Hemorrhoids). The important notable point was that there were no side effects or adverse effects shown after the treatment. Further extensive research trials are advised. 

 

CONFLICT OF INTEREST STATEMENT: Author declares that he has no conflict of interest.

 

*Ayurveda Medical officer, District Ayurveda Health Center, Khandbari, Sankhuwasabha, Nepal

 

Acknowledgements

 

Author would like to appreciate support of District Ayurveda Health Center, Khandbari, Sankhuwasabha, Nepal

 

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